Introduction Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting.Methods202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition.ResultsAcute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%.ConclusionOur findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

The presence of MetS seems to be associated with increased incidence of AKI after cardiac surgery. MetS is a modifiable issue; if its components are well controlled its dreadful effects after cardiac surgery might be controlled as well.

SUMMARY OBJECTIVES This study was conducted to reveal the possible protective effects of ticagrelor and enoxaparin pretreatment against ischemia-reperfusion (IR)-induced injury on the lung tissue of a rat model. METHODS Wistar albino rats were randomly divided into 4 groups as follows: group-1 (control-sham), group-2 (control-saline+IR), group-3 (ticagrelor+IR), group-4 (enoxaparin+IR). Before the ischemic period, saline, ticagrelor, and enoxaparin were administered to the 2nd-4th groups, respectively. In these groups, IR injury was induced by clamping the aorta infrarenally for 2 h, followed by 4 h of reperfusion except group-1. After the rats were euthanized, the lungs were processed for histological examinations. Paraffin sections were stained with Haematoxylin&Eosin (H&E) for light microscopic observation. Apoptosis was evaluated by caspase-3 immunoreactivity. Data were statistically analyzed using the SPSS software. RESULTS In the lung sections stained with H&E, a normal histological structure was observed in group-1, whereas disorganized epithelial cells, hemorrhage, and inflammatory cell infiltration were seen in the alveolar wall in group-2. The histologic structure of the treatment groups was better than that of group-2. Caspase-3(+) apoptotic cells were noticeable in sections of group-2 and were lower in the treatment groups. In group-4, caspase-3 immunostaining was lower than in group-3. In group-2, apoptotic cells were significantly higher than in the other groups (p<0.001). CONCLUSION Based on the histological results, we suggested that both therapies ameliorated the detrimental effects of IR. Caspase-3 immunohistochemistry results also revealed that pre-treatment with enoxaparin gave better results in an IR-induced rat injury model. In further studies, other parameters such as ROS and inflammatory gene expressions should be evaluated for accurate results.

Bulgular: Hastane mortalitesi 18 hasta ile %3.6 oranında gerçekleşti. Kaybedilen hastaların on altısında koroner arter cerrahisi, birinde mediastinal kitle nedeniyle operasyon, bir hastada da göğse bıçaklanma nedeniyle açık kalp cerrahisi yapılmıştı. Yoğun bakımda ve serviste takip edilen hastaların 137'sinde atriyal fi brilasyon gelişti. 11 hastada yara yeri infeksiyonu, 3 hastada mediastinit, 33 hastada düşük kardiyak debi mevcuttu; düşük kardiyak debi gelişen hastaların 23'üne intraaortik balon pompası yerleştirildi. 5 hastada böbrek yetmezliği, 12 hastada solunum yetmezliği, 7 hastada nörolojik disfonksiyon görüldü. 2 hastaya atriyo ventriküler blok nedeniyle kalıcı pacemaker yerleştirildi. 15 hasta kanama ve sternum ayrılması nedeniyle revizyona alındı. Sonuç: Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi koordinatörlüğünde açık kalp ameliyatlarının uygulanmaya başlandığı hastanemizde, ilk 500 vakada mortalite ve morbidite oranlarımız kabul edilebilir düzeydedir. Kliniğimiz, ameliyat sayısı ve çeşitliliği ile sağkalım oranları açısından değerlendirildiğinde, il genelinde toplam yedi açık kalp ameliyatı yapılan merkeze sahip Kocaeli'de ilk sıralarda yer alan bir merkez konumuna yükselmiştir.